Wheelchair Letter Writing To Please The Insurance Companies and Medicare

It can seem overwhelming if you have never written a wheelchair letter for coverage. In addition to providing the reasons why you or someone you know needs a wheelchair it is good to provide the specific reasons why the different parts of the wheelchair are important.

Keep in mind the multiple considerations that will ultimately dictate your selection of a particular wheelchair. Considerations include the strength, range of motion, orthopedic status, muscle tone, and cardiopulmonary status (heart and lungs-shortness of breath, etc.).

Other things to consider include the potential for change in functional ability or size, need for an adjustable or rigid frame, the method of propulsion whether using arms and/or legs, positioning needs and environmental needs that will determine the types of tires, casters, etc. that you will need.

Be sure to include specific reasons for the various add ons in your wheelchair letter by relating the prevention or benefits that the wheelchair user will gain.

Who, What…

The “who, what, when, why and how” are what it is all about. If you have the medical reason, the mobility or lack thereof, why it is needed, when it will be used, how the chair will be used then all you need to add is the specific chair with the different special features and you will be ready for the next step of your wheelchair letter writing.

Doctor Review

The doctor will review the wheelchair letter and will need to sign it before the equipment provider will proceed with the ordering of the wheelchair. This is a very crucial first step in purchasing a wheelchair, whether it is a manual wheelchair or a power wheel chair.

K-Codes

Medicare classifies wheelchairs into different codes, so attention to details when deciding on the right wheelchair is vital to payment or denial. There are different classifications depending upon the particular needs of each individual. These codes are used as many wheelchairs have some of the same characteristics. You may want to specify this in your wheelchair letter.

Details

If you are detailed and specific with your wheelchair letter you will have a better chance that the cost of the wheelchair will be covered by insurance. This is why you need to have a good understanding of wheelchair parts and have good communication skills to “paint a picture” of the wheelchair for the insurance company or Medicare.

Some of the different terms are listed below that you may find useful. Your best description will come from the wheelchair equipment provider advertising.

Terms For Useful Prescription Writing

• Push handles - These are used to assist the client with mobility and propulsion. They can attach to the backrest or the frame.

• Backrest - This is the upright portion on the back of a wheelchair to which the seat is attached. The height is determined by the amount of support needed by the client. Manual wheelchairs should allow for unrestricted use of the upper extremities.

• Armrests - These are used to support the arms. If they are positioned too high, they can cause shoulder elevation. If they are positioned too low, they can cause shoulder subluxation and can contribute to poor posture. Users with good upper extremity function may not use armrests because they may interfere with movement. Different types include, fixed, removable, adjustable, desk, full length, flip-up. Be specific when describing why you might want a flip-up versus a removable type

• Wheels - These include the rims, push rims, axles, hubs, attachment of the axle to the rim (either spokes or mags), tires, and tubes. Tires can be pneumatic, semi pneumatic, or solid. Some wheels are heavier than others while others require less maintenance, etc.

• Axle plate - This is the receiver for the axle, connecting the wheels to the frame.

• Axle position - This is the axle's position in relation to the body. A forward position makes the base smaller and the wheels easier to access. However, the wheelchair is more unstable (more likely to tip over). In addition, the forward position makes performing a maneuver to bring the wheelchair on to its 2 back wheels (i.e., a "wheelie") easier. Moving the wheels back increases the wheelchair base and makes access to the wheels more difficult; however, the chair tends to be more stable.

• Wheel locks or brakes - Attached to the frame, these block the wheels from moving or turning; some clients require extensions. They also can consist of front caster locks.

• Wheelchair anti roll back or automatic lock brakes – These brakes are usually used in long term skilled nursing facilities when a client does not remember to lock the brakes before getting up and prevent the wheelchair from rolling. They have a spring that is located under the seat, that when pressure is applied the brakes are released, or moved back from the wheel. When the person starts to get up they pinch against the back tires. The Safe T Brake system attaches to the wheelchair handles and apply pressure to the wheels automatically, can be locked in place by the attendant, released and allow the chair to fold.

• Camber - This is the orientation and angle of the wheels in relation to the frame. Zero camber is straight up and down and provides the narrowest width, but it makes the wheelchair less responsive. Positive camber increases the responsiveness of the wheelchair but also increases the width. Sports chairs typically have 15° or more of camber.

• Frame - This is the skeletal system of the wheelchair, which supports the seat and provides for wheel attachment via the axle plate. The width of the frame is critical to mobility. A proper-fitting frame allows the individual optimal access to the wheels. A narrow frame is more functional and can more easily negotiate environmental barriers. Although growth should be considered in pediatric wheelchair frames, the wheelchair must fit the child. Historically, wheelchairs have been ordered with the intention that the child would grow into them. To place a person in an ill-fitting wheelchair is a true disservice to the user.

• Foot Rest/Leg Rest and footplate - These support the legs. Heel straps may need to be added to the footplate to keep the feet from getting caught in the front casters. Elevating, Articulating leg rests are usually meant for edema management in the therapeutic sense. For Medicare reimbursement use caution as most of the time it will be justifiable for an orthopedic problem.

• Front casters - These are the smaller wheels on the front of the wheelchair. The smaller the wheel, the more responsive the chair; however, smaller wheels tend to cause the ride to be bumpier and make it easier to drop into a crack on uneven ground. Bigger wheels tend to be harder to turn, but they do better outside and on rough terrain.

• Seat sling or seating pan - This supports the cushion or seating system.

• Cushion characteristics and types - If a cushion is to be used on a wheelchair, then factors to consider are weight, shear forces, pressure distribution, heat dissipation, and moisture tolerance. The ideal cushion should be functional and comfortable, provide pressure relief, and be easy to use and cost effective.

• Lateral Supports and Neck/Head Supports are available for proper alignment; again give the reason why you would need these. Lateral or side leaning due to orthopedic diagnoses or neurological such as a stroke for decreased contracture, proper alignment, etc.

• Drive controls- There are several different types such as joystick, head controls and sip and puff. With the power specialty chairs be sure that you have had some practice time before ordering the final chair.

• Ultra Lightweight, Light Weight, Standard Height, Hemi Height, Bariatric, Heavy-Duty, Pediatric, Tilt-in-Space, Rigid, Adjustable -These are categories for measuring the weight, height, size and type of wheelchair.

• Several categories of cushions are available on the market today. This must also be justified or you will get a generic foam cushion. Be sure to give specific details as to why you need the special cushions for seat as well as back.

Summary

To summarize your wheelchair letter writing to please the insurance company and or Medicare be sure to have the patient diagnosis, wheelchair specifications, special features, cushions, weight of chair, etc.

The physician must sign the wheelchair letter and then it will need to be sent to the durable equipment provider along with the insurance information for the wheelchair user.

This can take a little time to complete and be sure to be thorough in your exam and measurements. Wheelchair letter writing can be made easier if you follow these guidelines.

Remember you are spending someone else's money you want to get it right the first time.



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